It’s the doctor’s fault.

I came to clinic at 9.15 am the other day. I was held up in the wards and was fifteen minutes late. My patient, a 40 year old housewife with poorly controlled diabetes was fidgeting outside my room. She was unhappy. I could tell. She entered my room and started berating me for my seeming lack of consideration for her time. By the time she was done, I had apologized a dozen times. We started with the consultation and to my chagrin, she forgot to bring her home sugar monitoring chart. Her blood sugar control was abysmal and her kidneys were starting to leak protein. She was obese and still gorges on fast food despite being counseled by a dietician. She has defaulted her appointment to the eye doctor because she felt ’her eyes are just fine’. She has not been taking her medication for the past week as she was visiting her sister and forgot to bring it along.

Before walking out of the room she had the temerity to say this: “ If only you could spend more time with me, you could have treated my diabetes better. You just had to be late.”

She walks out. The next patient walks in. And the cycle repeats itself…

This is a common scenario faced by doctors. We bear the brunt for everything that goes wrong in a patient’s life. The poorly managed disease, the horrid weather, the ungodly waiting hours, the uncomfortable waiting room chairs, the grumpy nurses, the lazy attendants and at times the odious smell that emanates from the person sitting next to them.

We face these frivolous accusations and absorb them, giving our patients an outlet to vent their frustrations and anger. We tell ourselves, “This is part of the job”.

We live by the same mantra regardless of our nationality, color, religion, race or creed… “The patient is ALWAYS right”.

I have listed the following complaints based on my experience and that of my colleagues.

The doctors are inconsiderate towards the patient’s time.

You are probably right. We are inconsiderate. We are inconsiderate for abandoning our health so you could be healthy.

We are inconsiderate for skipping our meals and not giving in to the excruciating pangs of hunger so we could monitor your fluids when you are down with severe dengue.

We are inconsiderate for not returning home to have dinner with our family and loved ones because we are too busy consoling yours.

We are inconsiderate for missing our daughter’s dance recital or our son’s football match because your child was admitted to the intensive care unit and without us being there, will probably never make it through the day.

We are inconsiderate for forgetting our wedding anniversary because our mind was filled with the thoughts of our patients undergoing complications in labour.

We are inconsiderate for placing our patient’s well being above all else, including our own personal time. We should have considered our family and friends before spending so much time at work. We are very inconsiderate indeed.

The doctors are selfish and spend very little time during consultation with their patients

An average doctor sees ten to fifteen patients in clinic and this number varies according to hospitals around the world. The larger the pool of doctors, the lesser the number of patients they see, and the amount of quality time they are allowed to spend with their patients increases.

Bearing in mind this simple logic, if the consultation time runs from 9 am to 1 pm, which is exactly four hours, and in a clinic with roughly ten patients per doctor; we are only allowed 24 minutes per patient.

This does not take into account the walk in patients, the forced bookings, the late comers, the ’missed appointments’ who decide to turn up on that day, the ’selective amnesiacs’ who got their appointment dates wrong, and finally the ’self anointed VIPs’ who probably donated a few dialysis machines and built the entire south wing of the hospital.

If you have been to a hospital, have you ever wondered why our clinics don’t finish on time? Have you ever wondered why the doctors are still seeing patients during their lunch hour? Have you asked your doctors if they have had their lunch or at least a bite to eat from morning?

If you do, I guess you will find out how ’selfish’ they really are.

The doctors have ’special preference’ over certain patients compared to others

You are absolutely right! We won’t even bother denying this.

Picture this scenario. A patient presents to the emergency department with a massive heart attack. Time is of essence. In case you didn’t know, every second wasted is detrimental to the patient’s life. The doctor knowing this well, rushes to the emergency unit, pushes the patient to the cardiac care unit and performs a life saving procedure called ’angioplasty’. He may have to leave his clinic or the wards, where the stable patients are waiting to see him, who are at present in no danger whatsoever, except probably a bit annoyed of having their discharge from the ward delayed.

We may have to delay your MRI appointment for an hour, as patient may come in with a spinal cord injury requiring urgent radiological diagnosis and surgical intervention.

A pediatrician may take an hour of her time to review a child in an acute cubicle but may only spend minutes with your child who is well and awaiting discharge.

We recognize the ‘frequent visitors’ to our emergency department. And we know the ‘funny feeling’ you have around your fingertips at 3 a.m can wait while we attend to a patient brought in unconscious after an accident.

There are times the operating theaters are fully booked, that we need to postpone elective surgeries to accommodate urgent life threatening cases. We can’t proceed with removal of a lipoma from your hairy back if a mother with fetal distress arrives in labour. If an emergency Caesarean Section is not performed in time, we could lose both the mother and her baby.

You can’t imagine our trepidations when we approach your bed, as we prepare ourselves mentally for the verbal abuse that is about to follow, knowing in full knowledge that you have fasted the whole night prior to surgery.

You will inadvertently be mad. We know. And we can’t help it. We do have ’special preferences’. But what you don’t realize is this; it’s best not to be one of our ’special preferences’.

The doctors are supposed to know everything about us and don’t have to keep looking at their notes

Patients have accused me of showing little interest in them if I can’t recall every detail of their symptoms, admissions history and medications, especially if I have to keep referring to my notes.

I am often left embarrassed by the cynical looks some patients give me when I am unable to answer all the questions. Even when I say with all honesty , ’I will look into it and get back to you’, the disparaging remarks can be quite hurtful.

I have often wondered if a lawyer is able to recall with exact precision every case he has tried? Can a teacher recall at will the details of every one of his students examination results? Will a bank manager remember every single detail of his client’s account?

The doctors are responsible for our health and it’s their fault if we don’t get better.

We are responsible for our patient’s well being. Only a fool would say otherwise.

We can continue to admonish obese diabetic patients to lose weight and control their diabetes but they don’t heed our advice. They return time and time again for more medication and continue deteriorating and get upset with the doctor when they develop complications from the disease. They assume it’s our responsibility to fix things as they pay taxes.

We can only counsel a patient with scarred lungs to stop smoking and to be more compliant to their medication, but if they choose to continue smoking and disregard our advice, are the doctors to be faulted when they have done nothing to help themselves?

It’s still difficult for us to comprehend the unrealistic responsibilities placed on doctors.

There is a quote by Rumi, “Out beyond ideas of wrongdoing and rightdoing there is a field. I’ll meet you there. When the soul lies down in that grass the world is too full to talk about.”

We are not perfect. We are not trying to be. But our patients often forget as they tend only to look at the ’thorns’ in their lives, that we, the doctors, are ’patients’ too.

Related

187 responses to “It’s the doctor’s fault.”

It’s everbody’s fault I think. Try being a patient and u’ll know how it feels. Im a medical student and i can see how busy doctors are. But at the same time ive been admitted to ward and i can feel how suffering patients are waiting for scans,blood results etc when the etiology of my disease is still under investigation. So yeah i think everybody should understand each other and try not to blame other people. 🙂

Dear Lee, thank you for your comments. I just would like to add that there are others who really appreciate what we do. They may even be the silent majority who don’t use flowery words or flashy gestures to show their gratitude. And they make this profession worth the while.

Try not to be disheartened by the vocal minority of patients. Your work is clearly of huge importance to many people and throughout your career I imagine you will improve the lives of literally thousands of people. This is an incredible achievement most people cannot even aspire to in their lives. People in all walks of life are impressed by this even if you don’t get to hear about it. The comedian John Cleese from Monty Python’s flying circus is one such man who is famous for his guilt in this regard. While he entertained millions he felt he could have put his private school and university education to a more noble purpose.

Also understand that the reason that a person in a state of perpetual decline due to their illness that is theoretically within their power to change who blames it on you does so due to their mental state. Can you imagine being in a situation where you are trapped in the cycle of self loathing that leads to you doing the exact thing that you should not in solace. There is only one way to cope with that kind of existence and that is denial. The person knows really that it is their fault, that they are the problem they just hurt too much to be able to do anything about it, they’re traumatized by the embarrassment of having to see their doctor and explain how they are worse than before. Knowing it is their fault and that they will get worse. It is those feelings that cause them to snap out and attack you and others who are actually helping them in the same way the unpopular child at school snaps out and is rude to those they could have befriended as they expect more critique and perhaps by acting strong in that way gaining some small measure of respect.

At the end of the day they just don’t want to admit their fault and by apologising to them then you are giving them that gratification. I don’t know about the legal ramifications or your practices guidelines but it seems to me that you might be a little at fault if you do let them get away with this time and again. How will they change if you let them play their game?

Some people sadly can’t be helped. That must be incredibly difficult to stomach but don’t let them ruin the fulfilment that caring for others can give you and definitely continue to use the outlet that is the internet to de stress!

We do understand that. To get attacked from every single angle when you’re motivated to take it on is completely different from being overworked, tired and never being thanked at all (or feeling that way). It’s the same way in sports: why does the coach always get fired when the players aren’t doing the work? On the same token, 24 minutes is NOT enough to connect with your patients. We are FORCED to do 4-5 hours of computer work a day on wards, and are admonished for “cutting and pasting.” Oh! And dont forget about “patient satisfaction!” Oh! But don’t work more than “80 hours a week”! It’s all bullshit. Rules are imposed on our seniors which are imposed on us and then on our patients. The guidelines we are forced to impose affects our “outcomes” to some bean counter, and after awhile, you can’t ignore it. And the author seems to be a personally reasonable physician who sucks it up 99.99% of the time, and many others have also thought about trying to elucidating the same sentiment. The .01% of the time venting was probably the 1 day off in 3 weeks or a post-call day after working 28 straight hours.

Doctors, I sympathize. Patients, especially those on the receiving end of free or subsidized treatments, should get over themselves and look beyond their short nose. There are others that are dying so no, your ingrown toenail or itchy back or dry eyes is not life threatening and really can wait another hour or four! I wish I could tell patients if they don’t wanna wait, they are welcomed to go home! Keep up the good work doctors!

The sad reality is that we try to be politically correct by saying that the patient is always “right” or just by keeping quiet. But the contrary is the truth. Medicine is the only profession where the patient is almost always wrong and dependent on the docs to get well and the doctor have infinitesismal more knowledge and wisdom than them through years of hard work/slogging. that why self medication does not work. No wonder so many law suits nowadays. My old learned professor once said’ you never get sued for telling the truth or being perceived as rude for telling the patient off so long as your diagnosis and Rx is correct , but you would get sued for the wrong diagnosis or wrong treatment no matter how good your bedside manners is”. I am begining to think how right he is as I see alot of people being unreasonable and fault findings(always other peoples/doctors fault) is the game nowadays. I see alot of doctors making the situation worse by apologising when they have not done anything wrong, thereby making the patients have delusions of grandeur and more likely to whine and take legal action for the slightest whim when things go wrong. have some self respect please and do NOT apologise to whiners.

This is absolutely correct. Doctors have enabled and created this situation where now the patient is a “customer” we have to please instead of a patient to treat. Doing the right thing isn’t always what the patient wants or what will make him/her happy.

I have met many self-entitled patients, rude patients, and mean patients as a volunteer in a hospital. I’ve seen patients bicker about doctors behind their backs to nurses and bicker about nurses to other nurses.

The best I could ever do was smile and apologize for what happened and that I will make sure I never do “that.”

As a patient myself a few months ago when I came into the ER with a laceration to the hand, I understood what it meant to stay there for hours. It bothered me and it was uncomfortable to be cold while I was bleeding and cold, waiting for the stitches.

But still, having seen the medical side of things, I understand and I could not and would not take it out on the staff who worked there. They are there to help you as much as you are there to help yourself. Maybe if people walk a day in the shoes of health professionals, they’ll truly know what it’s like.

Whatever you say that is why Doctors are paid thousands to do your job properly.we know that you are humans but before you entered this profession and took your oath u already know the situations that you are going to encounter and face in your everyday life in hospital etc.so stop moaning and get on with it.we have all our own troubles in life the difference is you Doctors are better paid than us so i dont know why u even bother doing this blog.Godbless &more power to you

Were u trying to say that their dignity is so cheap that it can be bought with money? That their forgotten family at home can be valued by that extra money they’re making? That the disappointment of their child to not have a parent by their side during their milestone can be consoled with taxpayers money?

Paid thousands to do our job? Really? Actually, that sounds about right. Thousands. Not hundreds of thousands, not millions.

A graduate doctor comes out on minimum wage. The orderlies, cleaners, nurses, admin staff and most of the patients we are seeing are paid more than us. We are NOT paid better than you. We work a minimum of 12 hour days most of the time; calculate the hourly rate on a 50k wage, please. We keep doing it because we are committed to our patients and to our practice.

Thank you to the many other supporting people here. It is SO nice to see this rather than the “shut up and just do your job” comments that are so often seen. For example, There was an article praising the neurosurgeon in Europe who jogged to his job through the snow – the nasty comments there made me question whether people actually want doctors around.

Vladimar kebeng, something is seriously wrong with u.The blogger is talking about the attitudes of patients nowadays and their indifference which is not helping their health. U need to re wire those fuses in your tiny little brain. Grow up for God’s sake. And btw, DOCTORS DONT BECOME DOCTORS TO GET A FAT PAYCHEQUE. Only retards like u will do something like that.

I love it how some people think that if you are paid well then abuse is alright – ‘stop moaning’ is the same statement made every time a doctor has the audacity to point it out. So by this logic I’m guessing it’s ok to racially vilify someone if they are well paid. Can I be sexist if I am the client of someone who makes a good living? Can I be a bully? How about a bigot? Is there a limit? Can I physically abuse someone if they make decent cash? Surely at the very least I can blame all of my personal issues on them – I mean it’s the least they can do, right?!… Why do I get that feeling that you are taking this personally because the article describes you.

Thank you Breno – Just – Thank you for saying this.
Of all the fights I have to have – fights with insurance companies and pharmacies, paperwork, sometimes with administration – Of all the fights I have to have in this job of medicine, the internal fight with patient criticism is by far the most disheartening.

The truth is that even poorly paid people get this. I worked in retail forever and then as a CNA. You know what I hear when I complain about entitled jerks mistreating me? “If you wanted better treatment you should’ve stayed in school! You knew what you were getting into. Don’t whine when at least you have a job!!” Cruel and belittling behavior is never an okay way to treat another human being, EVER. Some people will find any rationale to excuse their selfish, bratty attitude.

We get paid (precious little) to do our jobs, not to endure demeaning treatment by patients. Would you talk like like this patient to a traffic police officer who stops you to issue a summons? No! You would smile and plead and beg just to get out of trouble. But I suppose it’s fine to be nasty to a person whose job is to help you?

Do your research my friend… The amount of overtime we have to work for free means there are many weeks when we are getting paid less than minimum wage.. How many humans do you think have THAT much good will in them to put up with that? The NHS is an organisation surviving on nothing but good will (mostly ours). The least we deserve is to have a moan about it..

Where to start with the completely wrong assessment. Do you have any idea how much it costs to go to medical school? Do you know the opportunity cost of not going straight to work after college, rather taking another four years of study to earn a medical degree? Oh, and it does’t end there. The shortest residency in order to master one’s craft is 3 years. That means a solid 7 years of working incredibly long hours (that do not end when one leaves the hospital), just to get to the starting line of one’s ‘job.’ You have absolutely no idea what doctors do. I suggest a little more research before making and ignorant statement that ‘doctors are better paid.’ Amortize the average salary of a doctor throughout their life and I believe even you will be shocked by how much less than the ‘thousands ‘ it really is.

that’s the trouble with patients like you who equate everything with money and things just because you have money , you are entitle to lord over others or as a patient you can boss people around. get real. doctors being paid thousands are still very much underpaid compared to bankers who does little and get millions even when they screwed up. For your info, you have a choice. if you are not happy with a doctor or hosp, bugger off and go elsewhere. Likewise I know of Doctors who refuse to treat unreasonable patients. Its their right. this is a free world. It works both ways. that’s life. no poiint whining.

Did you even READ the blog? Buddy, we are not paid “THOUSANDS”. That is laughable. This blog has stated what few others would say. It is not an attack. It is an outlet for a professional to vent and explain why things are the way they are. Don’t put up some wall and say “meh, you make more, so shut up.” That’s not how it works. To be so ignorant as to shade the profession with such a shallow statement would be to miss the entire point.

Doctors are paid more because they are in serious debt from learning how to treat. You. They are still paying off their land at the time of retirement and a lot of their extra salary goes toward that, not to mention most work 80 hours a week and are also paid more for that.

Oh cry me a river. You really are a martyr aren’t you? Here’s a tip if you hate your patients as much as you seem to it’s time to get out of medicine. Nobody’s forcing you to inflict your “care” on patients.

I cannot believe that audacity of some people. You have no idea!!! If it’s not complaining about how much we get paid, it’s we don’t care enough, if it’s not that we have targets to meet enforced by the hospital. Unlike other professions we do not even have the luxury to go home and and leave work behind us at the end of the day. No, papers and research are not going to do itself, the letters that patients receive do not write themselves, the next post-grad exam is not going to sit itself. If it was as simple as other jobs where you go home at the end of the thag would at least be something, but we don’t even get that.

Now moving onto forcing our care onto people, I went into medicine because I enjoy being able to make people better. The stupid part is, over the years patients like the one described above who just have no interest in helping themselves clog up clinics, a and e and the hospital. Patients have developed this idea that they can just thrust thier illness onto the doctors looking after them and they should be the ones to fix it. Why is it so difficult for patients to actually LISTEN to what we are telling them? I sat once in a bariatric clinic and for 4 hours it was a repeated cycle of I eat a small banana for breakfast, a single slice of bread for luch and a salad for dinner. I don’t know how I weight 25 stone and demand for the surgeon to fix it!

I can however appreciate that unless you are in a position of responsibility for peoples lives on a daily basis, it is difficult for you to understand what that level of anxiety feels like, especially after being on call for 48 hours and having slept for half an hour here or there, because you were dealing with complex medical decisions and informing families thier loved ones have passed away, to then be expected to take your scab that keeps falling of in the shower that you are just so worried about seriously.

So why don’t you try looking from a perspective that is not so tunnel visioned?

She never said she hates her patients, she’s expressing her disapproval over the abuse and blame that she endures on a daily basis at the hands of rude acopic people. And there is no shortage of them ready to speak out it seems. Like the last guy, this article clearly touched a personal nerve. Here’s a thought, rather than attempting to justify your abusive attitude why not try to be a better person? The answer, because it’s easier. Why change when you can project.

I see no evidence of hatred here, just the standard frustration of anyone in any profession that’s trying to help people. Whether you’re talking tech support, social work or medicine, many of the same challenges come up again and again. And one of those is people who abuse the service and yet seem persistently to miss the opportunities left available for them if they use it correctly.

And there’s no reason why medical personnel should have to shut up and take the abuse when it does happen.

you sound like one of those unreasonable patients. likewise you have a choice. if you are not happy with a doctor or hosp, bugger off and go elsewhere. Likewise I know of Doctors who refuse to treat unreasonable patients. Its their right. this is a free world. It works both ways. that’s life. no poiint whining.. Nobody ask to teat you. you asked to be treated in the first place!!!!!

Your trolling comment (after having read your blog and all the replies that follow this comment above) should allow us the opportunity to connect. You are not the type of patient we are referring to. You wrote about the minutiae that we ask you about as a TYPE 1 DIABETIC because IT MATTERS. Missing doses of insulin matters because you can become much more ill A LOT FASTER than a type 2 diabetic. I guess it’d be more appropriate to respond to your blog, but I’m assuming you see an endocrinologist or a very detail oriented physician. I’m sorry that it’s annoying to you to know what your sugars are, but THIS IS OUR JOB. Your gripes are irrelevant to this particular blog. Unless of course: 1.) you are late to appointments 2.) don’t monitor your sugars regularly 3.) make necessary dietary changes. There is a danger trying to simplify things to patients when in fact the issues are much more complex. Don’t take this blog as an attack on patients who are frustrated by their chronic conditions. Just understand that we don’t come to your job and complain to you and blame you for what a shitty job YOU’RE doing.

I think you need to realise that for a number patients an encounter with you is merely an opportunity to inarticulately vent their frustration with their lives. Through no fault of their own they were not born with your ambition, intelligence, wit nor likely physical fortitude, nor have they the (even self-motivated) education to emancipate themselves from this. Their glycaemic control is an irrelevance when taken in the context of the directionless, purposeless, poverty-stricken (of wealth, thought and spirituality) monotonic fuzz of misery. They have no great interest in helping themselves as they cannot perceive the benefits of doing so. There probably are no benefits. As a doctor you’re a very easily accessible (much more so than e.g. a politician) member of a society that they never really stood a chance in. A consultation with you is an opportunity for momentary empowerment. Why begrudge them that? And of course you should try to tackle their medical problems, and deal with the disillusionment that ensues. But mayby there are other challenges there too?

Dear XY, beautifully said. I hold no grudge over any of my patients. My annoyance and frustration stems from the fact that they do very little to take care of themselves. I am frustrated that I cannot do more for them. No amount of education or counseling seems to work. They are aware of their health problems but assume it is only the doctor’s responsibility to fix it. This is where the interminable difficulties lie.

I believe I am still learning and adapting in this profession and as you have rightly pointed out, there may be other challenges too. Thank you for you comments.

I don’t think it’s satirical – if it is, perhaps I’m missing the point… I used to have the same problem when I worked in a coffee shop (one of the biggest in the UK). The customers would take out the frustrations of their day/life out on you when all you were doing was serving them coffee. The stories I could tell! With doctors I imagine it to be even worse because they actually have a duty of care and some patients will take advantage of that as much as they can.

Carla is correct: no satire intended. Perhaps a gentle side-swipe at my (the medical) profession, but the sentiment is genuine. To believe that we can improve a patient’s quality of life by ensuring that their e.g. cholesterol conforms to a national guideline is delusional, hubristic and fatuous. We can, however, be of enormous help by listening to their problems, making them laugh, easing their pain, remembering what prize their grandchild won at school etc. All very easily acheived in a short consultation. My point is that the patient’s agenda is often not your owm, and that the purpose of the consultation is to find out what it is, satisfy it, and then try to address your agenda, with the knowledge that it may ultimately be pointless.

We are all dealing with our own demons – intelligence, finance, and position does not change this or protect you. With this in mind the doctor doesn’t use this to unload on the patient, so why is it traditionally ok for the reverse. If the patient has an issue with the system then voicing that is fine, abusing the medical staff is not – and allowing abuse to afford a down-and-out person a moment of empowerment isn’t ok either. That is ridiculous. There are no decent excuses and the medical profession ought to be fed up. In a world of anti-bullying, anti-racism, anti-sexism, anti-agism, etc etc etc, it amazes me that people still line up to support abuse of clinicians as if it is their god given right. Why does the term ‘tall poppy syndrome’ leap to mind?

I think you are absolutely spot on with some really key points about where the patients are coming from. But why begrudge them that? Because obviously there ARE actual benefits to being able to deliver good medical care to patients that are compliant with that care (otherwise disease would just manage itself, everyone would live forever and we wouldn’t need healthcare professionals, medicines or a healthcare system) and the cycle that ensues from patients using medical consultations as counselling sessions greatly ruins our chances of modifying disease progression/minimising the effects of a disease on a patient. It is a disservice to a patient to have a medical doctor as counsellor (we don’t have a counselling skill set to offer) and financially ruinous to an organisation paying doctor’s salaries to people who are actually instead (poorly) fulfilling the role of a counsellor.

As a medical registrar, I find your blog a little disrespectful. My experience of 4 years has shown that 99% of patients are extremely grateful for the work we do, I’ve rarely had anyone blame me for being late( as long as you give an apology).

By doing medicine you were warned that you would have to miss birthdays etc, to attack the patient for this in my opinion is really unprofessional.

You also seem to take it very personally when you don’t know all details about a patient. With correct communication skills and honesty this should never escalate to a problem. A quick apology and “as you can appreciate I will need to jog my memory of the details” is usually all that’s required. Besides it’s important for us to know as much as we can about our patient pre seeing them in clinic- it makes for an accurate consultation

I agree in comparison we don’t get paid that well.

Appreciate that patients are scared, they take fear out in many different forms. And lastly if is patients choice whether to take our advice or not, as frustrating as it may be we can’t enforce our advice. My best advice here is try and build a rapport with your patient instead of seeing them as someone trying to be obstructive. That way they may just trust your advice.

But seriously someone blaming the patient like you imply suggests to me that medicine is not the correct career for you

With patients seeing the NHS in the news for all the wrong reasons we need our doctors to stand united and show our patients that despite all the restraints we are giving our best and have them at the centre… Whether they complain or not!

Its a pretty big world my friend. Just because you have never encounter such patient doesn’t mean its false. They are plenty. You are one of the lucky one then. A lot of us here don’t think Dr Raj’s blog is disrespectful. he is not blaming patient. He is just saying that there are limit to our aids toward patient’s health. Failure in their own contribution shouldn’t be attributed to a doctor’s incompetency.

Wow, bit of a whinge fest there….someone had a rough day at work. There are some understanding ppl and there are some rude ppl in life, no matter what profession you are in. Most less severely ill pts are reasonable enough to understand that doctors are busy seeing more severe pts as well.

Dear all, thank you for your comments. I am overwhelmed by the response to my blog entry.

Let me clarify my stand on what I have written here.

Most of us don’t hold grudges against any of our patients. We are frustrated by our attempts to counsel and treat you when you do nothing to help yourselves. The onus should not fall solely on the doctors to care for your well being.

To construe this blog entry as a vicious attack on patients; you obviously missed the whole point.

Some of the comments are beyond my realm of judgement and comprehension to construct a suitable reply. I will approve all comments as long as the language isn’t offensive.

I am steadfast in my belief that I can never win an argument with a person at the opposite end of a moral spectrum or with those on an entirely different intellectual plane.

Also why not stand up for yourself if you feel you are being wrongly abused/accused?! Pts aren’t gods, just because you have to treat and respect them doesn’t mean you have to put up with their disrespect.

I would just like to point out to JPS that the gratitude (and expectations) of patients also sometimes depends on the specialty and locality of those patients. I absolutely agree that in the UK (if this is where you’re based) patients were far less ‘ungrateful’ or blaming of doctors for their situation and were often v grateful for the help of myself and my colleagues, even given the limited resources.

I’m not sure where this doctor is based but certainly I have found in my current setting – Australia, the picture to be very much as this doctor describes with patients and relatives being frequently abusive, denigrating and downright disrespectful to doctors, nurses and other hospital staff, expecting a level of input and 1:1 care way above the level a public service is able to offer them. I get the impression that they believe we’re not trying our best because we’re not working in a private hospital!

This doesn’t mean that we don’t still put them at the centre or give our best, but I do think it makes more and more staff consider a career out of public service medicine, which is a total shame.

Doctors should make those who arrive late wait. I am on time or early yet constantly told the dr. Is running behind because off a late arrival. Other than that… Agree with all you say. Maybe, however, you should have called out the diabetic lady on her hypocrisy.

Great blog! As a healthcare professional I can see that you really care about patients and that’s why these little comments eat away at your soul. Unfortunately the reality of today’s society is people are self-entitled, impatient, and always looking for any easy fix to their problems. You have a variety of health gurus , the internet, and ‘experts’ that make being a healthcare professional even more difficult as you have people questioning you constantly. It’s frustrating at times but in the end just deliver the best patient care you can and there will be so many great moments to redeem the bad ones! Keep up the good work !

(Side note: unfortunately the reality is that people do become doctors, dentists, lawyers etc for the money and prestige but then either thrive or become resentful.)

Well, I’ve been on both sides of the doctor patient divide. I cannot say I have any solution, but I realize that even minor illness can be very distressing and people can be very irrational, myself included, when they are sick.

All you can do, is do your best in the circumstance you are in and the resources you are given. If you know you have done your best for them, you will learn to care about complaints that matter, and grow thicker skin for the ones that you can’t do much about. As a doctor, (like a nurse, a lawyer, a fireman, a policeman or even a personal trainer), you can only help people who are willing to help themselves. I have always told my patients that they are the ones with the illness, they may not want it, but they own it, so they have to take responsibility for it. I am only here to help them beat it. And its totally ok to let it out on your bad days, but just remember to enjoy the good ones!!

Though I do agree with many of the points made here, this post does read like quite an angry attack on patients and I wonder if it is somewhat misplaced? The way that healthcare is run and managed forces doctors to neglect their own health as they try to cram in the ever-growing waiting list. It probably sounds idealistic, but I think healthcare could be run better to reduce both the frustrations of patients and doctors.

I think you should have apologized once and left it at that. The patient is NOT always right. We don’t work for them but for their benefit. It’s not always the doctor’s fault. I would have told her off when she went too far.

This was a great post and I can identify with the points being made, I have no shame in saying that there are occasions when I feel equally frustrated with the way in which patients or their relatives communicate their discontent.

I think one of the major issues is that our patients’ experience is framed by the small amount of time that they see us face to face and they have no opportunity to work inside the healthcare system to appreciate the stresses and constraints that we face during our working day. It is therefore not surprising that they too have reasons to be dissatisfied with the healthcare system.

The difficulty I feel, is that rather than being appreciated as fellow human beings we are often perceived as a commodity providing a service that is funded (in the UK at least) in part by the taxpayer. In my limited experience as a junior doctor one of the difficulties of the job is finding the balance between providing good patient care and being receptive and responsive to patient criticisms and concerns with managing our own stresses and workload.

I disagree with the comment that suggests that feeling frustrated with patients is an indicator that ‘you are in the wrong profession’. I would be more concerned to come across a doctor who has no opinions and concerns about the environment that they work in. Our healthcare system is far from perfect and there is a long way to go to address the concerns of both patients and staff. But without vocalists for change what hope do we have of improving it for the better?

Nobody denies your effort. For some of you. But our health dept sure could improve many thing, just a lot of thing to make their service better. People who were going there is in pain for some reason, they are sensitive. But whenever I went to a hospital, there are a lot of thing they could improve. It was like nobody is there to make things better. Whatever it is, despite of your noble effort, there are still more rooms for improvement.

i love this article!! it just sums up what i have been thinking of recently! It can seem quite unfair sometimes that we have to put up with this behaviour. I remember one night shift I was covering NICU, the paed ward and paed AE and all were heaving and then a stable patient who I could discharge home was left waiting to the irritation of the father who started shouting at my junior, who was then near to tears. When we are not with the patient where do these parents think we are?? because you can bet we are not sitting on our bums drinking coffee in the drs mess!!

Health isn’t just about fixing medications and blood results. It’s about the fear & terror of being a patient in a system that you don’t understand, and having some understanding of that. If a parent shouts at you because they’ve been waiting when their child is well, they have spent that time in fear that something is seriously wrong.
COI: I’m a paediatrician & a patient. It’s not easy being a patient, and I understand how the health system works. Do I take my medication every day? Keep my diary? Follow my meal plan? No, because doing all of that means being a patient every second of my life, and that is a huge mental adjustment. And I understand what that means.
Nobody should be abused for doing their job, but please don’t assume that being a patient is as easy as “following the instructions”. We see patients for 30 minutes of the day, and yet we think we can judge why they don’t rearrange their whole lives to follow our dictates.

Hmm what worries me about this is the profound lack of empathy you display towards your patients. Just like you are also a father, husband, friend, so too are your patients subject to multiple pressures on their time and emotions. You seem to stereotype from the worst to characterise everyone in front of you as a selfish idiot who can’t manage their own health. I work in HE, as such I have trained for ten years, work a 60 hour week and I can assure you I earn half your salary if not less. Saying that, I would never ever discuss my students in this way, and I would think if anyone did, they shouldn’t be in the profession.

Plumpskins, no desire whatsoever to be a doctor, the hourly rate of pay sux 🙂 Honestly it was the cartoon at the beginning which got me offside to begin with, having encountered retinopathy problems after 33 years of diabetes. My BMI at the time was 21, I have had type 1, (autoimmune diabetes ) since I was 1yr old, so I find the Dr’s sense of “humour” and lack of compassion regarding a condition I had but did nothing to bring about myself, quite distasteful. My initial response was probably motivated out of disgust at the cartoon but I don’t resile from that position.

Andrea L, no I am not rude when I see Doctors, they treat me and I treat them with respect and courtesy. If I was unfortunate enough to come across a Dr who was rude and contemptuous of patients in general, say they, oh I don’t know mocked patients with retinopathy as though eye disease was always the patients’ fault I would likely tell them they’d be better off choosing another career and of course I’d put in official complaints as appropriate and wouldn’t see them again (luckily I have that choice).

Believe it or not I am totally sympathetic to the ridiculous hours doctors are expected to work, I think it’s a health hazard for all concerned. I know A&E Drs and nurses are subject to horrendous abuse and assault from patients who have taken illicit drugs and I’m sure that many patients transfer their anger and frustration inappropriately towards the Dr who is trying to help them BUT I don’t think that justifies doctors taking out their frustrations about the system on their patients either directly or via a blog. Patients don’t choose to be ill and to come to the hospital, Doctors do have a choice about their career so to portray the doctors as victims in the healthcare system does not elicit any sympathy from me, you have a choice, either constructively work towards fixing it, suck it up or move on. Patients can’t do that.

in all seriousness Dharmaraj, we all have bad days at work and we all whinge about clients and need to vent. I’d strongly advise against doing so in such a public way, it could be damaging to your career, there’s no such thing as anonymity on the net and once it’s out there it’s out there and nobody cares that it was just a low moment after 30 hours straight work and 10 of the patients/clients from hell one after another.

Ah, right. I must say I didn’t read it like that — sounded to me like the patient was blaming her doctor for her health conditions, rather than the other way around. If I were a doctor and recommended that a patient see an optometrist, but she didn’t because she didn’t think it was necessary, I’d be frustrated if the patient then said her ill-health was due to my lack of care.

hahaha! damaging to his career? Don’t worry about that! I know him personally, and he will have no lack of patients/client. He has a great personality. You disagree about him venting out on the net? but even the thrash collector vent out on the net nowadays. You don’t have to read it if you disagree right? But here you are venting out(boo.. Dr have low pay thats why i won’t become one. I sympathize with their hours and abuse but they have a choice right? Why else would they become doctors if they don’t wait to be abuse?). Is that right? And he’s not really venting out. He is just sharing his experiences, which many can identify and relate to. After all, i think it’s our responsibility(as a community) to stop all form of abuses. Don’t you think?

Besides, believed it or not. This guy is not really frustrated about the abusive patient. But more to his inability to do more for them, as he is expected to be fully responsible for his patient’s health. After all, in the long run, you alone are in charge of your own health. So, what choice do he have but to work towards fixing it? Hence, sharing his opinion and experiences to raise awareness on patient care. I think it will be a good start. Better than sucking up and not doing anything. He’s not getting paid anyways.

It was never my intention to mock any patient’s medical condition. I can understand where you are coming from and believe me when I say this, I would never have said anything to make light of your condition.

I never mentioned anything about the pay structure of doctors in my article so I will not comment on something I never said. I never joined this profession for financial gains and I stand by that till this very moment.

To assume I lack empathy towards my patient is probably misplaced. Had I lacked empathy would I care for their well being and in turn be frustrated when they do nothing to help themselves? I know the patients with real problems and those with attitude problems, believe me. The ones who assume they know more than the doctors after reading a few articles on the internet. And let me assure you, they are the vocal minority.

The vast majority of patients are appreciative and grateful to what we do. The have insight and are willing to join hands and fight the battle together. They are the silent majority. I have said this time and time again. Please read my other blog entries and the first comment I posted on this one.

I wrote this entry based not on my experience alone but that of many others. I am based in Malaysia and I have friends around the world who say exactly the same thing to me. I was trained as physician via MRCP (UK) and spent a few weeks working in London. I have heard the same complaints from doctors there.

To hear of doctors never being abused by patients throughout their career is indeed heartening. I wish we were all that lucky.

I don’t believe I mentioned names in my article or singled out a particular person intentionally. But I will heed your caution in future regarding the lack of anonymity on the internet and how it could damage my career.

Melinda, please believe me when I say this. I cannot see myself doing anything else other than this. Being in medicine is the reason I wake up in the morning. Even if I can’t see the sun, I know it’s there. And this sun is invincible. I wish you the best. And I apologize for the hurt that the cartoon caused. Take care. God bless.

This is quite an interesting read. People have the freedom to voice their opinion, the opportunity to hear those varied opinions, and the privilege to weigh the information, take it or leave it, and apply it to the best of their ability. In my personal experience as a nurse I have witnessed the broad spectrum, from devoted doctors who over stretch their bladders and miss meals, to the calloused doctors who stubbornly take time online to check stocks, admire sports cars or dream about vacation spots while patients are waiting. The struggle is to find balance of demands, pressure, satisfaction and pleasure. It’s life. The vast differences in humanity make up the world we live in. As the patient or the staff, there are varying degrees of education, experience, expectations and vulnerability. The patient is coming for a service trusting that the doctors knowledge and experience will be helpful to them. While some patients with irrational expectations revere doctor’s as healing God’s, some doctor’s as well have irrational self important ideals. It is eminent that patients are educated that they have a responsibility to take part in the care plan if they expect results. It is often a lifestyle adjustment on the patient’s part that helps obtain a favorable response from the tools provided by the physician and team of educators.
I do not support the statement that the patient is “always right” or feel that a heartfelt apology needs to be repeated several times. In the case mentioned, the patient was using valuable time with the doctor to vent, which directly had an effect on the amount of time the doctor had to spend on her care. Each person has their own opinion of the value of their time. From the housewife who perhaps had to hire a babysitter or is under time pressure to pick up a school child, to the person who has had to rely on someone else for transportation or the professional who had to arrange time away from work. Either way, communication and working together as a team is our best hope. I have observed that it is not unusual for an office to run late, in fact 15 minutes is pretty good! It is a rare pleasure to come across an office that is able to run on time. In this case, the communication begins at the front desk when patients check in. The receptionist informs them of approximately how far behind schedule the office is running. It has been my experience that people grumble, but appreciate knowing this upfront. The patient can be reassured that in the event it was their own emergency requiring the doctors time, they would have the necessary attention and therefore can appreciate the reason for having to wait. Usually the patient has had ample time to vent before the doctor enters the room. A good nurse is a sounding board who intercedes between patient and physician. In the event of a much longer delay, the communication between a doctor and his staff is crucial. Staff can inform the patient ASAP. Especially if able to reach them by phone before they are on the way to the appointment. Empower the patient to make the decision that works best for them if they prefer to reschedule. Sure, who doesn’t get irritated when things aren’t going according to schedule, but again, this is life. We can only do our best and all reep from the benefit of working together.

I am sick of doctors complaining that they have it bad. You treat your patients poorly. Do not address the underlying causes of their illnesses. Treat their time as if it were unimportant. And then have the temerity to complain when someone calls you out on it.

The hospital doesnt have enough beds to take care of all the sick? Then the doctors have failed in recommending proper expansion.

The duabetic is having trouble losing weight? Blame her, rather than help her.

Someone is on medicare? They don’t deserve proper care anyway.

And the patients can’t realistically make another choice. They are captive in having to see the doctor they do, because thwre isn’t another one covered by their insurance. There isn’t another hospital for 200 miles.

It’s annoying when you have to wait 30 minutes for a late appointment – trust me, I know (I had leukemia and the amount of follow up checks i require is insane). But when it’s your turn, or a family member/friend’s to really need immediate care, then you’ll be glad for their immediate attention.
And a doctor has to care about anyone and everyone. Yeah, some people make bad life choices but if they need more care than you, then they will get it on time.
The hospital doesn’t have enough beds isn’t a doctor’s concern, rather those managing the hospitals. It’s a lot more complicated than that.
And why doesn’t someone deserve care if they’re on medicare? What, rich people deserve better care because… they’re rich?
You get care based on when and how you need it.
That system is the only one that works in the medical industry because it’s not a business like other things… it’s something anyone and everyone needs at some point in their life.

Thank you for this post, it was a really good read and made me think. 🙂
I try to be nice to my doctors, in return they trust me when I say that something feels wrong with my body.

Once though, I got really ill (at the age of 23). I had a perforated bowel, and had to have an operation. My doctor took took real pride in his work, and so he did a keyhole surgery.
Anyways long story short; he didn’t get it all and as my fever got worse they had to do another operation.
At the same time the country I was currently in, had massive floods. The doctors kept putting off my surgery to the next day, resulting in a few days of me not being allowed to eat. Luckily it turned out that I managed to fight off the last remains of the illness on my own, thus when the flood subsided, I didn’t need the operation.

I’m saying this as I have to confess I reacted badly during that time. I was beat down, and in bad spirit. I just wanted to get better and I felt like the doctors wouldn’t let me. When they came in the first day to tell me that I had to wait yet another day I yelled(or grumbled as I didn’t really have yelling strength) at them. I blamed my doctor for having done keyhole surgery something that “could have killed me!!!” and all that overreacting mumbojumbo.

The truth is that I needed someone to let all my frustration out on. I felt so bad and unfairly treated by the world I needed someone to “blame”. I didn’t want to blame my mom, as I wanted her support and love, then there was only the people who “personally” made me wait for surgery.
My doctor was a brilliant man. True, he didn’t really care a single bit about the people, but he loved his job. He tended to my wounds and my bodies well being, with pride.
I never said thank you to him. I truly and honestly feel grateful now, but it took me a long time to see how unreasonable I had been.

So I suppose I’m saying thank you to you instead. Sorry if you have had someone like me, and they never came back to you to thank you. I mean it though, I am thankful for having had him as a doctor and I am thankful for all the nurses that helped me.
And of course, thank for understanding how horrible I felt, and letting me yell my empty angry words in your direction. 🙂

As an emergency doctor I found your article and the comments that followed it very interesting, I really enjoyed reading both sides of the arguments and was neither greatly moved by your blog nor offended by those who were not sympathetic to your views.

There seemed to be a conspicuous lack of middle ground though.

Yes some patients that come through the door are unpleasant to interact with and require diligent professionalism to ensure you do your work appropriately, but others are kind, generous, interesting, and often downright hilarious, and the balance in my experience tends toward the positive overall. At times I’ve had awful experiences with wealthy, highly educated patients and at other times profound moments with those driven towards suicide by their drug addictions. You never can tell, and judgement is best left in the change rooms when the scrubs go on for a shift.

On the whole we are not highly paid, but neither do we work long days for a pittance. We are at the very least comfortable and secure relative to the rest of society, a fortunate position to be in.

Our fields require extensive study and experience which can be extremely challenging in many aspects, but allows us to derive much satisfaction from our work when we are able to do it well, and grants us an overall position of respect in the community. Yes some people unfairly dislike us as doctors, but there are those who idolise us and that is no better either.

It is a challenge to balance time with the job and families can suffer because of this, there is no question that the work is hard and days are often long. But doctors as a whole are of driven, high-achieving personalities and their dedication to their work is often not exclusively from a sense of duty to a medical oath but also from a personal wish to excel and be recognised for doing so.

It is easier as a doctor to point out the flaws in the way people live their lives, we are trained to know such details and what effects they have on the health of the human body. But doctors too suffer under alcoholism, smoke cigarettes, fall to drug addictions or eating disorders, and despite all their knowledge and training are, like their patients, not immune to feeling pain in this life and turning to unhelpful escapes in order to deal with this.

The quote I would like to use is from Epicurus: “the only time we are unhappy is when our expectations fail to match up with reality”. If we expect to be enormously wealthy, adored by everyone who meets us, highly competent, free to spend leisure time as we please with friends and family, personally motivated and energised at all times… We will end up unhappy.

But we can expect to have moments at either end of those spectrums, with patients and colleagues with pleasant or unpleasant personalities, and times where things seem either wonderful or too god damn hard.

The expectation should be that we do our best in any of those fluid situations, and to have the good grace to forgive those who might not live up to our own possibly unreasonable standards, just as readily as we praise those who are a pleasure to deal with.

This is an amazing post, but there’s just one issue. The high level of sarcasm used will not be understood by the people who are stupid enough to commit these atrocities. The people who agree with what is written here (and that’s the vast majority) are already smart enough to not do any of these negative things. Keep up the great work; the silent respect that people have for you far outweighs the disrespect that you’re forced to endure.

Dharmaraj Kartikesan….Without meaning to disilusion you , unhappy patients who may try to vent their frustrations on you will be with you till the day you retire and new ones will replace those who are not around to complain, to complain about doctors who come after you. Thats the nature of the game. Just like with bad and unsympathetic doctors beinga minority, ungrateful and forever complaining patients area minority too and on the whole the majority on both sides get along reasonably ok with some amount of mutual respect. Reality check….You will never be liked by everyone and everyone will not be grateful even if you do some something great for them over and beyond your calling. Never, never apologise profusely for being slightly late. You are offering your back as a doormat. Instead, always smile sympathetically and say , ` Thank you very much for your patience in waiting to see me. I appreciate that ` etc courteously. You are still in the teens of your career and may you never end up getting burnt out and always be hopeful of the sun being out there even when you cant see it. Ignore mosquito bites from critics here, who have their own unhappiness to bear, knowing that their medical condition will never go away and think that its your fault and that you have to be apologetic. Have better vision than that. Good luck.

Dear Murali, this post was not written out of anger. I was frustrated with certain patients but I have always maintained that the vast silent majority are brilliant with us.

I would also like it to be viewed as my attempt to defend the actions of doctors which is often misconstrued as inconsideration toward patient’s care. I spoke to many before writing this. I wrote so they can be heard.

I am aware that one can never be universally popular or loved. Most of the comments here are encouraging. Others may have differing opinions. I have to respect that.

Your comments are truly appreciated. I am only in the infancy of my career, as such I am bound to mistakes and inappropriate emotional response.

Having just come back from my doctor, I didn’t have time to read all your blog post, but it would not have been unreasonable of you to have ‘berated’ your patient for not bringing her sugar chart, the other details she needs to provide YOU with, for not keeping up with the régime you have worked out for her. It does work both ways.

You take it on the chin. That is admirable. But your patient has to know she has a responsibility too. If she is not told that, the problem repeats itself, again, and again, and…

Just wanted to say that it is appalling how some people treat doctors. In fact it is appalling how some people behave and treat others in general.
I do sometimes get annoyed at long waiting times, but I would never complain to the doctor about it. I’m grateful they took time to see me when others have a more pressing need to see the doctor. I always try to follow “old-fashioned” manners when I go to see my doctor. I always knock before entering the room and make sure I thank them for their time before leaving. That said in general I say thank you whenever I asked for help from staff wherever I am – for example if I am in a supermarket and can’t find something and ask a member of staff where the product is I will always thank them for their help and time.
Well done for doing what you do. I always respect someone who is a doctor, they give of so much of themselves often to their own health detriment. They just wish to follow “First do no harm” to their patients.

I was once a PSA with a govt restructured hospital and have also faced every other thing you have seen.
My only consolation to you as a doctor is that, many other people in many other different trades feel the same as you.

Why?
Seemingly because as we become a first class nation in terms of monetary value and GDP and whatever KPIs that can exist, we become a third class citizen in terms of character.

Most of the patients who come in for an appointment are either:

1) Children of elderly patients who need to rush back to work, and even being one minute late puts their job position in jeopardy.
2) People who took time off from work for the appointment.

Get it? Its for the measurement of KPI yet again.
We lack grace, empathy as a society on the whole, have low tolerance and are selfish – its all about fufilling our own KPIs. And it is contagious.

But more importantly saying sorry doesn’t help things to work out the next time. Because by saying sorry, people don’t think much of the reason why you are late – and that you can’t help it. And probably the next time u end up late again, they think “Sorry” is something you should say.

I think you should say: I’m sorry, I tried my best to rush here, was in the emergency prior to the appointment and If I could help it, I hope that that person did’nt collapse and needed to be resusitated, and of all times they need to collapse now (during your appointment) instead of later. They should have collapse later, don’t you think so?

I think sometimes you need to let them feel guilty, because they just need to be feel “bought over” that you as a doctor, am very concerned about attending to them. Or else, you would have to stress yourself out attending every single thing on time and not pioritzing important procedures of life and death nature (Saving lives in short).

As a patient, I would like to apologize for every time I took you for granted, showed up late, missed an appointment, didn’t follow instructions or took my frustrations out on you. You couldn’t know that on one particular day my doctor’s appointment fell in between twin tragedies in my life. There is no way you could know my whole family history and recognize that my inability to focus far outweighed this chronic illness. How could I expect you to understand that all the negative in my life would cause me to believe that I was unworthy of love and nurturing? Please forgive me for placing you and most other physicians up on a pedestal. It was wrong for me to assume you knew everything about medicine, patient care, bedside manner, and murphy’s law. I see where I slipped up when I thought that you could heal everything. I know now that I put too much faith in your ability to prescribe passion first and everything else second. Interesting enough, I also know that many patients have a difficult time expressing how much confidence they have in their physician. They sometimes express that confidence by continuing to show up, trying harder the next time, referring other patients to that physician and paying the bill either through their wallet or their insurance premiums. My commitment to you in the future is to be more conscious about how my business for you should be conducted and how your livelihood depends on it. I’m sure your monthly nut is so much bigger than mine, I want to extend the compassion also.

whiniest post EVER. From one healthcare practitioner to another, if your patients refuse to follow your advice or are unable to change, you are not presenting the information in the right way. Be MORE creative and patient centred and less entitled, boring and whiny.

whiniest reply EVER!!! From one healthcare practitioner to another. He’s the most creative and imaginative guy ever! have you read his blog? He can be a writer. No this guy does not yell or scream at patient. He fine tune them. What’s that? You have never heard of that. You got to be more creative yo! now go use your imagination. Boring and whinny one!

I really appreciated your quote “You are probably right. We are inconsiderate. We are inconsiderate for abandoning our health so you could be healthy.” I am nurse in a center city university hospital who spends all day making sure her patients have their meds, fluids, food, activity, time with their loved ones, and I am “inconsiderate” when I have to use the bathroom or take a drink of water once in 13 hours.

As an orthopaedic surgeon, I’m not supposed to be cuddly or bother with patients. But an elderly couple came in today whom I have been treating for something or other for about 20 years. Neither needed much orthopaedic attention, but we sat and chatted for a while. I wrote a prescription or 2. They left saying that they really appreciate me as their doctor, since I’m the only one who listens. That made my week, and it’s only Monday!

To the original poster – your description of the “silent majority” and “vocal minority” in the comments section is spot on. I’m finishing my internal medicine residency in the US and mentioned this same pattern here to my mom. At her next gynecology appointment, she made it a point to thank her doctor for years of care. Her MD started crying in the exam room because she was so touched to hear “thank you” from a patient – something we know that silent majority is thinking but rarely expresses in words.

Interesting. I think we’ve all had patients like this. I’ve definitely been screamed at by some patients, and have had to learn to keep my temper controlled (after losing it a few times). It’s just something we learn to deal with. But there’s one thing I never do, and that’s to apologize when I know I am not in the wrong. And I have scolded patients sometimes, but with their clear understanding that it is only out of concern for them. I tell my patients that the advice given is not for me, but for their own good. After all, it is not my health that will be affected. Sometimes, though, we also need to find out why they’re non-compliant. Often, socioeconomic issues prevail. Sometimes, it’s just plain stubbornness and a lack of self-control. It IS frustrating when you spend an hour trying to educate your patients and at the end of it all, all they care for is to get their pain medications (and you know they’re not going to stop smoking or start exercising or change their diet or take their other medications). But what can we do? We’re only human, we can’t force feed our patients their medications, or control the food that they eat, or force them to comply with our advice. We do our best and move forward to help the next patient. Moreover, if a patient accuses you of not really caring for their well-being, it will hurt, but you know better than anyone what your motivations are. Let it not change who you are and how you treat your patients. We just move forward and do what’s right.

Oh good lord, another whining doctor. Reading you previous post entitled ” I am a doctor” was equally bad. You need to get off your high horse and stop thinking that your profession deserves to be put on a pedestal. There are so many jobs out there that are equally or if not more stressful than yours. Yet for some reason, it’s always the doctors that whine the most and make the most noise, take up newspaper space complaining about their hours and what not leading everyone to believe that they have such a horrendous life. There are many accountants and lawyers (just as an example) who put in way more hours at work (including take home work) than you, and whine less. Tell me Dharma, once clinic is over, on the days when you are not on call…do you take work back home with you or do you leave the hospital at 4.30pm and have a great night not bothered by work? Im assuming you’re an MO, not a HO.

Get real. obviously you do not know what it takes to be a doctor. No other profession comes close to one when it comes to sacrifices . The demands are tremendous and I should know as I been through it all. FYI it takes at least 20 years to be a specialist from HO to MO to fellow or consulting to senior consultant/prof level.I spend more time at work than almost all otehr profession , at least about 100 hours . after work I need to do work related research, readings, passing countless of exams, recertification for courses, teach juniors, nurses, attend to crap complaints from unreasonable patients, etc etc. Exams are no joke when they are exams with only a 10% passing rate!!! and at the end of the day you still have to see condescending patients like you who talks crap and whine. Do you ever wonder why doctors have the highest rate of divorce, suicides, alcoholism etc of all profession??? Oh yeah, you probably think they ask for it given your insolent posts. Like I said, you have a choice and can bugger off to another hosp or doctor if not happy. Nobody ask to treat you. Likewise a doctor have every right to refuse to treat an unreasonable patient and recuse himself. its a free world. Thats why some doctors just gave up and go to private sector and earn millions you begrudge them too? if you are capable, why don’t you try being a doctor before condemning someone. talk is cheap.

DR says “talk is cheap” and also suggests that we “get real”. But the in addition to those well crafted words also says “Do you ever wonder why doctors have the highest rate of divorce, suicides, alcoholism etc of all profession???” No actually I wonder why you would come here and either knowingly spread false information or unintentionally show your ignorance of the actual data by spreading what is incorrect “conventional wisdom”. Either way credibility is now an issue.

Consider these quotes easily found by Googling the topic:

Doctors face the same divorce rate as everyone else- somewhere in the 49% to 50% range. Interestingly though, among physicians there seems to be a great disparity of divorce rates based on sex and practice specialty. According to one US study, psychiatrists have the highest rate of divorce, with surgeons as the next most likely to divorce. Interestingly, it appears that doctors married to other doctors have a much lower incidence of divorce. A 2002 study found that they have a relatively low divorce rate of 11%

“While it may be chilling to think of the family physician or specialist you see having a problem with drugs or alcohol, the reality is that doctors are no more immune to substance abuse than the general public. In general, according to various studies, the rates of illicit drug use among doctors is less than that in the general public. With prescription drugs, however, the rate of misuse is five times higher than that of the general public.”

So, since you can easily get samples, write your own prescriptions, and raid your own supplies – you have a higher incidence of prescription drug abuse. And this is somehow surprising to you? Please! It’s a self-fulfilling prophecy !! We should be astonished if this were not the case.

Why on earth are doctors expected to pussyfoot around these creatures. If they were to tell it as it is I’m sure some management wonk would set disciplinary action in motion. Bet you wish you could say:
Madam…..You are grossly overweight and the vast majority of your medical problems are entirely your own fault. I will do what I have spent many years being trained to do and endeavour to help but your best course of action is to eat less and stop eating rubbish. In the meantime if you find my skills inadequate I suggest you go elsewhere

Dear all, thank you for your comments. As I have said previously, I will approve all comments as long as the language isn’t offensive.

I will not however reply to comments which lack neither context or comprehension to what I have posted in this blog. And I will not argue or try to prove my point with a person at the opposite end of a moral spectrum and those on an entirely different intellectual plane.

This was not written to whine about our job. It was written to defend the doctors and to allow you to see our side of the story. I was written in frustration over SOME patients who place unrealistic responsibilities over the doctors to manage their well being and do nothing for themselves and blame us when things go downhill. It was written to show you the abuse we often face when we don’t live up to their perceived standards.

And again I would like to state that these are the VOCAL MINORITIES and don’t represent the vast SILENT MAJORITY. My first comment on this blog cleared that up.

This blog never mentioned about the monetary remunerations of the job. The assume that we are complaining despite being well paid is delusional. Nothing has been mentioned in my writing here regarding this issue.

Being a doctor is a 24 hour job. After being on call, we can still be called by our juniors to consult on cases. I am a physician and at one point was on call for 4 weeks in a stretch at a district hospital (I was the only physician there; a common scenario). On bad days I can be in the hospital till the early hours of the morning. And I still love my job. Working hard has never been a problem for most of us. We do bring home our work in terms of journal and research publications and training of postgraduate doctors is usually done after office hours, which by the way rarely ends at 5 pm. Simply because no disease comes with an appointment.

To assume this blog post tries to place doctors on a pedestal and trivializes other occupations is another comment taken out of context. It was written for exactly the opposite. To tell you NOT to put doctors on a pedestal and place unrealistic expectations on us. We are not perfect. And we are not trying to be. Are we reading the same blog I wonder?

A reference was made to my previous blog titled ‘I am a doctor: The mythbuster’ as another literature written by a whiner. It’s possible you never reached the last paragraph. If you did you would know its true context and comprehend the meaning behind it. If I elaborate my intent, then I am going out of context!

I never expected such a response for my blog entry. It’s a humbling experience. To the doctors working tirelessly to care for your patients, I am always there for you. Work with compassion and allow yourselves to be ‘human’ once in a while. I will continue to write, so you can be heard. God bless.

Actually I just wanna comment on your reply to the patient when she claimed that her condition would be better managed had u spent more time. U dun have to apologise. It is not your fault so dun tell her that. *u r spoiling the market coz they will continue to have this mentality that patients r always right*

Instead of saying sorry it won’t happen again because u know it may happen again. U could say sorry for the delay it was because u were caught up in some procedure before this.

So when the patient said that her glycemic control wld be better if u had been on time. Just tell her u dun see the link n ask her if she need to lengthen the consultation with u if she has some other concerns so u r taking away her chance of trying to put the blame on you.

dun say sorry if it is not your fault. Patients r not always right. And u r selling your expertise and is not a customer service thing. So it is not a service line. They r not always right.

As for the rest of your “complaints” it sounds like your rantings. Is like patients r not in healthcare industry they dun understand what others do n the etc. It is quite understandable as they r in distress. Well u can’t expect ALL patients to be understanding n not complain. This is just like telling passengers not to complain and whine when the trains breakdown.

Thank you for your comments. In hindsight I admit it was my mistake for apologizing for something that is not really my fault. But had I tried to reason with her at that point, the conversation would have dragged on and she would have never left my room without having the last say. And other patients were waiting! It’s not fair to them. It was my mistake for being late. I just wanted her to leave the room without any more provocations on my part.

I am definitely not expecting every patient to be ideal and perfect. And this is not my experience alone. I have written regarding the cumulative experiences of my colleagues.

You have your point, I respect that. But now I have made mine. Even if it does sound like me ranting, please allow me the occasional indulgence to be ‘human’. I pledge to do better. God bless.

Welcome to life. You are not the only profession that has these problems. When you choose to help people it comes with the territory. Many appreciate you, you dont do this job for pats on the back you do it to help people even those who are jerks. I know some ppl are terrible thats just how it is, those who won’t listen, ask them to go to a new Dr. Don’t sacrifice your family for theirs. You do not get a 2cd chance to be a dad. Good luck in the future.

I did not mean to make it sound ok that you are treated that way.. But that it is what you get in dealing with people. Follow a Minister around for a month and you would not believe what some ppl say!! Keep helping ppl it’s worth it.
God bless

True story. As a teacher, we get a mountain of other ridiculous complaints and hate. But to be fair there are a million blog posts and articles about how shitty teaching can be too. Why not let them share their own frustrations here?

Most client facing professions “bear the brunt” of whatever is affecting the customer. It’s human nature to take their emotions out on you, whether intentionally or not, just as you are doing to them in this article. Also, I doubt most intelligent people are blaming you for their ailments.

It sounds like a lot of what you’re describing here are problems with the current state of the health care and treatment system, and you shouldn’t take that out on your patients.

We know you are doing noble work, and we appreciate that. But keep in mind you chose that on your own, so try to minimize the complaining.

Put yourself in the patients shoes. Everyone is on a schedule and nobody likes having their time disrespected, regardless of how prestigious you think you may be.

Don’t forget, to them, you are just an appointment in their day, and if they’re not happy with the service they receive, they will go elsewhere.

The best patient is a motivated one. This stems to many diseases, including obesity, diabetes, smoking, psych disorders. Now trying to motivate a patient that has been eating a lieu of carbohydrate laden foods every meal for the past several decades poses a serious challenge. No medication will “cure” this. And changing the way a patient perceives food or anxiety or depression is key–it’s psychological and will take time. Likely several visits/months, maybe years. This is going to be the challenge to come for many years ahead.

I find another problem being the expectations of patients, which is what Dharmaraj i think is touching on here. Time of the visit is just one part. Lab result return time, having 10+ problems to cover in one visit, billing, medication refills, office accessibility to patients–>all of this patient’s now expect to available 24/7. They want their lab results that day. They want an all-in-one-shop. They want their med refilled within the hour (this includes narcotics, without a visit I might add). They want to discuss all their problems in 10 minutes, including the wrinkles on their face and vit D levels–but not just to tell you, but they expect a thorough explanation. They want a lot. This is whether they have Medicaid/Medicare or private insurance. The main problem I see is that pt’s with federally funded insurances expect concierge medicine-type treatment and that expectation has to change. This is much bigger than office time, the entire healthcare structure and system has to change to optimize patient’s AND the physician’s overall wellbeing.

Keep in mind, a 15 minute visit will give a pt. about 8 mins to tell us what’s going on, 4-5 mins for the physical, and 2-3 mins to document. A 30 min visit–at least 20 mins for the history (a big difference). So if you have a lot to cover, I’d advise to schedule your appt with your doc accordingly and both parties will be much happier.

Just to add, I am working in a government hospital in Malaysia where healthcare is entirely subsidized by the government. The patients are free to leave and seek a doctor in private practice if they are unhappy with our service. Our healthcare system is well run and if I am much mistaken was ranked one of the best in the world. We are all paid the same amount based on a pay scale and not by the number of patients we see or a survey. Promotions are based on seniority in service.

Patients don’t need medical insurance to be treated in our government hospitals as healthcare is free, barring some minor exceptions.

The doctors on the other hand, are paid by the government to see ALL patients admitted under their care. We can refuse to see abusive patients, pass the responsibility to someone else, but out of COMPASSION and a sense of duty, we often swallow our pride and get on with our work, at times even apologizing for something that may not be entirely our fault. This should probably stop. It’s up to the doctor and the situation he or she is in. No one can presume to know better.

To those who want others to step into another shoe, try stepping into ours. We choose to endure the abuse at times, and remain silent, not because we hate our patients, but it’s because we care. If we were vindictive we can choose to avoid seeing them and since our monthly pay will not be affected, we can continue to keep the patient delusional about their own well being. We have that choice. But we fight the disease for them even if they have given up. We reprimand them and many a times we are successful. Don’t you dare assume we don’t care. Often it’s the patients who don’t care about themselves. And we know those with real problems dealing with poverty, disillusionment and a lack of insight toward their disease, and with proper counseling and treatment have turned their life around. And we also know those with real attitude problems who assume it’s their birthright to get better once seen by the doctor with minimal or no input from their part. Thankfully they are the vocal minority. But after years of tolerance, at times they can still get to you. Just being human after all.

I can’t and won’t comment on healthcare systems around the world since it is out of context from what I have expressed in my blog.

The only thing that is constant throughout the world is the unpredictability of human response, including how some have taken what I have written here totally out of context.

Maybe you should have provided some context for those readers who don’t follow your blog. This article was shared to me via social media by my doctor friends.

It seems they were the ones to have taken this out of context, as they were under the impression that this was an experience in the US Healthcare system.

What you are describing here is very specific to your environment, and thus needs stating SOMEWHERE in this article to avoid confusion. If you did, it would probably have prevented much of the hate comments you are receiving as people don’t properly understand the system in which you are operating.

Well, I did not expect by blog to reach such an audience. It was only read by my friends in Malaysia and Singapore prior to this.

Casting the issue of working environment aside, I believe wherever you work, the challenges for doctors remain the same. To assume have to suck it up and not say anything about it (as others have stated) is a little demeaning.

Although the occasional abuse is expected and absorbed by the doctors, it does not make it right. All the time.

I seriously cannot believe some of the things I have read here!!!! Apparently you Drs get paid thousands of pounds???!!! REALLY????????? Have you seen the actual pay scale of a Dr??? I agree that once they reach consultant level after studying hard for many, and I mean many years….. I doubt any Doctor reaches consultancy until at least 35, if not 40, they have been studying at university and within the hospital since they were 18 years old…. they have neglected their families, their friends, their health…. they have worked from the bottom up as there Is no other way to get there!! They earn every penny that have struggled so hard for….. And yes there are some Doctors that are rude, don’t listen, aren’t empathetic, etc etc, but when you compare them to say a footballer who earns £300,000 a week for training hard and kicking a football around, acting like an arrogant lout, and the Dr who has had his 5th complaint of the day for delays in the clinic, because he has been fighting hard to save a mother and babies life earlier that morning for example…. you can kind of comprehend why he might be a little distracted….. I work for the NHS and believe me, we do NOT get paid a fortune, we live in average sized houses, drive normal family (or even if you’re me… a small city car) we don’t shop for our weekly groceries in Harrods we aren’t extravagant unless we have saved for it, and sacrificed something else for it….. But you won’t find many of us complaining about you….. We might be disgruntled with the structure of the NHS or we might be short staffed, cos a colleague has gone off sick or has a sick child or relative, we might be feeling a bit down as we are grieving for a lost loved one…. But we do our job because we want to do the best for you… and we do take what you say personally….So yeah, go ahead and blame us if you chose to, but please remember we are human beings with feelings and emotions just like you, and we really do not earn so much money that we can all afford to retire and leave you to get on with it when we hit 50, even we’d like to!!!

Don’t put up with that bull. Give the patient a reality check. “Your diabetes is out of control because you have a terrible diet, refuse exercise, don’t take the medicine I give you, etc. Me being 15 minutes late won’t change that “. I know a doctor who shuts that complaining down quick and his patients love him for his reality. Just follow up with, “I apologize for being late, but if you don’t do as I say, then you are wasting my time as well”

I agree completely with this. I mean, what good does it do anyone to pretend otherwise? They may DIE! Let them know that! If they don’t care enough to change, then they can either keep on paying you for advice they won’t listen to or they can find someone else to work with. I don’t understand why this doctor is so apologetic to the rude patient. What would happen if they were mad at you for telling them the harsh truth instead of rolling over and apologizing? If you don’t show authority and confidence in what you are telling them then they aren’t likely to follow what you say.

Agree with almost everything you’ve said. Huge respect. There is just 1 thing that disturbed me. For everyone and anyone, their own child comes before others’, but NEVER EVER compare your child’s dance recital to another child’s life! You don’t need to be a doctor to make the right choice here. You just have to be human.

This sense of unappreciation can be applied to any job. While our jobs elsewhere may not serve as important of a purpose, we ALL feel this way at some point in our work. You sound burnt out, and as someone who is a good, appreciative patient (ahem, customer), I wouldn’t want to visit your office and feel the wrath of your frustration. Those are the people who are suffering, not the ones who place blame, but the ones who actually come to you for your advice and support in usually hard times.

Doc says:
We are inconsiderate for abandoning our health so you could be healthy.
MAJ says:
We are expected to abandon our health and safety so you can be healthy and safe.

Doc says:
We are inconsiderate for skipping our meals and not giving in to the excruciating pangs of hunger so we could monitor your fluids when you are down with severe dengue.
MAJ says:
We are expected to skip our meals and not give in to the excruciating pangs of hunger so we can continue the mission.

Doc says:
We are inconsiderate for not returning home to have dinner with our family and loved ones because we are too busy consoling yours.
MAJ says:
We have not returned home to have dinner with our family and loved ones in 9 months because we are too busy defending yours.

Doc says:
We are inconsiderate for placing our patient’s well being above all else, including our own personal time. .
MAJ says:
We volunteered to place our nation’s well being above all else, including our own personal time. .

And finally, two other points Doc. (1) Hunger pangs aren’t excruciating, but bullets and shrapnel definitely are. (2) And FYI my brand new 11B Basic Infantrymen are making a whopping ~$1532 a month. So hang in there Doc. I both respect your career choice and admire your sacrifices – but maybe, just maybe, your grass is a little greener than you think.

Thank you sir, I do appreciate it. And by the way, just so there’s no confusion.by anyone here, the term “Doc” in the military carries the highest respect and admiration and begins right here in the dirt with the combat medic.http://www.pbase.com/d_berry/image/89050776

They may call me “sir”, but they call him “Doc” and there’s no comparison.

Last year I worked at our government hospital for 3 months without getting paid, because our HR didn’t feel like loading me onto the system. This year, I have yet to receive my overtime for hours worked. I came to work on time every day. I worked my overtime every call. I treated each patient with the same respect as if I was getting an actual salary each month. And I am an attending. Not a houseman or MO. So I had the option to leave and go to private if I wished.
So if you feel like doctors are well paid, fancy folk who just need to suck. It up and stop whining, bear in mind that for 3 months, I had nothing. I lived off pasta and cheese so I could use my measly savings to pay my rent and basic expenses. But I worked. And I worked because like most doctors, I have compassion. I knew that if I didn’t come to work, my patients wouldn’t get seen. The que at the clinic would have gone on longer. Patients would have suffered. My colleagues would have suffered. And dozens of us in my country do this. We work despite not getting paid. Is there another qualifies professional who you can think off that would do this? Anyone who studied for 10 years to work for free essentially,with no confirmation when or if we would get paid?
So,to all those on this blog, who bang on about how terribly rich we are and how we get paid enough to put up with attitudes and abuse, think about whether YOU would do your job, under our circumstances, for free?

Actually, your post really does sound egoistical and trying to “play victim” here. Since u have agreed and reminded yourself that “it is being part of the job” then why bother to type a long passage of “rantings”?

Other professions have similar encounters like ie, nurses. If you think doctors get “bullied” the most, really? I think the nurses get more likely to be “bullied” as some would fear pple in the authority position.

Yeah, we all know u are successful and have a great career. Your job is noble, kind, loving and u put in a lot of efforts in helping the community at large and helping to improve their quality of health and so they can enjoy their life more. The majority of people are happy for u and appreciate the things u have done for the patients and trying your best all the while. We are happy for you that your hard works has paid off and you now have a successful career.

I think you should try to focus on the silent majority of the patients who truly appreciates your efforts instead of ranting about the cranky minority. And typed a long passage about how the cranky minority have bullied and take docs for granted etc. Most patients are appreciative and not like what you said. Stop playing victim.

well said article. Only doctors will understand what doctors go through. Even trying to make one understand it useless. So all doctors keep up the good work and continue to serve. there were so many times i thought medical practice is not worth the struggle. but when you see your patients getting better that is an awsome feeling… i know we being doctors on duty on new year or on our anniversary .. you miss on family get togathers, reunians and so on… but who cares.. people think its our duty since we r paid.. but is money everything??? and by the way we are not paid even more than they think… what to do … we just carry on with our profession…

“people think it is our duty since we r paid”. No! Wrong answer! And that’s what the majority of medical professionals complaining on this thread simply do not understand. People think it is your duty because it IS precisely that! It was your choice and now it’s your duty to perform. Period. You putting on that white lab coat committed you every bit as much as me putting on my uniform, the firefighter putting on her gear, the police officer putting on his badge. Welcome to the world of public servants.

But more importantly, how in the world can you be surprised about this? You obviously knew this going into undergraduate school preparing for medical school. This is NOT new news. And no one has even mentioned teachers as far as required education, job expectations and work environment versus compensation.

The one thing that physicians do have over the rest of us however is the fact that there are people walking around on the planet today strictly because of your skills and your efforts. I can’t imagine being able to claim anything any better than that..

Thank you for all you do, I sincerely appreciate it. But now how about we revert back to being the professionals we are, lead by example, and carry on? Of course we have our heartbreaks and frustrations, but airing them publicly is not the way to relieve them – in my opinion at least.

I do agree with Major that it is your duty to perform and patient’s safety and well-being must be the main goal, priority.

Having said that patient safety and well-being is the main priority, unfortunetly that comes at the expense that sometimes u may miss meals or having to work long hours or miss your bdays. It is parts and parcel of your career journey.

The part whereby patients are angry and place their frustrations on you, let’s just say this is really the minority that does it. If you realize that “it is not about u”, u would not have “internalized” it and feel upset, hurt by them. It is actually, I think patients they are in distress mode having to deal with illness and they have let their anger/anxiety/frustration control them.

Seems like u feel underappreciated, “burnt out”, stress by the cumulative effects of “bullying/abuse/complaints” from the minority of unappreciative patients. Still, it is not appropriate to “rant” publicly esp since these are the minority cases and that it is also parts and parcel of the profession. It seems “unlikely” the trend is gonna change after “ranting” coz the minority might nt be reading your blog.

Nothing is gonna change after this ranting. The minority of patients will still exist. Perhaps u may want to give them your url so they can come by and read your post so they can try to be more understanding and nicer in future. Or printing out your blog in hardcopy in the hospital/clinic newsletter for those waiting patients to read so they are not gonna step in and complain/abuse. I dun think the minority are reading the blog tho :p

It doesn’t seems like airing your rantings will gonna change anything. But it does give people who are not in the healthcare industry insights into the difficult moments that a doc encounter.

I think, a person who is strongly motivated by a genuine desire to help the sick when they step into this career wld not be ranting about the “sacrifices” they have to make and not getting appreciated. It seems like it is just the way things are. There are good and bad days.

That’s the worst excuse I can think of. just because you are being paid does NOT mean someone can lord over you or tell you what to do. that’s pathetic and cowardly. LIKE you said, everyone of us have a choice. If you are not happy with a doctor or hosp why whine. Discharge yourself to anotehr hospital or get a second opinion or another doctor. likewise I do not see any problem for any doctor to recuse himself or herself from treating any unreasonable patient. Respect works BOTH ways. if you want any doctor or for that matter any professional to treat you with respect, please show some respect first!!!!
that’s life and the beauty of freedom to choose. unfortunately there are always patients who think doctors owe them a living and come to hospitals thinking they are the only patient in the whole building who deserved their attention. No wonder the hosps in US are full and obamacare is not going to solve the problem.anybody who thinks he can do a better job feel free to become a doctor and change the system. talk is cheap and wpuld get you no where.

Doctors, like people, come in different flavors. Just thought I’d point that out, and recount one incident which might illustrate that. I was under cardiac care of a specialist. Mostly, the office visits were routine(I was taking better care of myself), and the frequency of these visits were uncalled for, since I had been stable for years. Anyhow, one time I had to go away suddenly on business for an extended period. By the time I realized I had missed my appointment, it was too late to call, and I couldn’t definitely re-schedule until I got back. Well, I got back about two months later, and there hadn’t been a single call about my missed appointment, a single mailed reminder or any other sign of concern for a missing patient. What I did get, though, was a bill for my previous visit. I could have been dead, and I don’t think that seemed to have entered his thinking(or the office staff’s thinking). I get reminders from those quick oil-change places that it’s time for my next oil change. I switched doctors, and never heard from my first doctor ever again. Yes, doctors, at least in the junior years and in certain specialties, do yeoman work, but one needs to judge them, like people, on an individual basis. They aren’t all altruistic, “I don’t care about the money, this is my calling in life, and my patients come before my family” types.

Maybe I’m in the minority, but I suspect not: As someone largely unacquainted with what goes on behind the scenes of the medical profession, I may sometimes perceive something to be the case, but in fact be mistaken, or not in full possession of the facts, or have inadequate knowledge or understanding of the context. If I make a complaint based on such an erroneous perception, I would far prefer that the professional explains why I am mistaken rather than apologise. By simply apologising when faced with this situation, you not only become frustrated, upset and stressed (particularly if this happens repeatedly) but you also bolster my faulty worldview, making it more likely that I will complain again next time – I have not been corrected and in fact now have a precedent!

By and large, I am sure that the majority of patients respect and are grateful for the medical professional, and that much of the complaining is based on such faulty perceptions, which therefore need to be corrected rather than internalised.

1) We should also be thinking about systems changes … More NP, PA, Diabetes educators, and restructuring payment mechanisms to value time spent counseling instead of procedures, which might help reduce the number of clinic appointments per day. Just a thought instead of pitting doctors against patients.

2) As an intern who is still struggling to save money for a bed frame and a coffee table, working nights, days, then nights again at 80hrs a week, often skipping meals and totally losing touch with my friends and family for 50k/yr before taxes and 150K in loans… I didn’t do this for the money, and I don’t think any of us are looking for sympathy. There is a big difference between asking for sympathy and merely asking people to educate themselves about the realities of this profession. So yeah, when I hear comments about doctors being inconsiderate or selfish, I’m not hurt, but I think to myself, there’s someone who clearly has no idea about the realities of this profession.

I was lucky enough to grow up in a family of medical workers, from reception to transcription to nursing. I was taught to always arrive at an appointment 30 minutes early, and expect it to be a hour late. My grandma always said, the better the doctor, the longer the wait because you never know who needs them more than you.

Dear Dr,s
I understand that you get a lot of rude patient’s, but why do some of you double book patient’s and then complain about not having time for yourselves and your families. Stop double booking and hire more Dr.s. You should have known it would be that way when you chose your profession, You make the big bucks and take multiple vacations every year. My husband has been going to a Dr. for two years, and has seen him one time. The rest of his visits he has to see the Dr.’s assistant. He pays a fortune for health insurance, but never see’s the Dr. When I see my Dr. and have several problems I want to discuss, he well say well let’s just focus on your cholesterol this month. So most of my questions get unanswered. Then I leave irritated and swear I will never go back. But I do, because there isn’t anyone that is any better, at least not in our little town. And I am certain that things are going even worse with Obama Care…

I think that most professions right now are having this problem of people expecting to be the most important customer of the year… and I think it has more to do with the self centeredness of our society in general and less to do with the quality of service at any/all of these professions. In the past 24 hours, I have read either the defending of or complaining about doctors, teachers, snow plow drivers, and mechanics and in all cases it seems the common denominator is the customer failing to realize that they are just 1 in many that are the recipients of the service and that sometimes, as you said, there are more important/time sensitive issues that are at hand that they are unaware of, not to mention the fact that the service provider has their own needs and, without taking adequate care of those needs, they cannot perform their duties, whether doctor, teacher, snow plow driver, or mechanic, with any degree of success.

Thank you for what you do, and from one often-attacked service provider to another, I wish you luck in all you do.

Dear dr. K,
Thanks for this blog. …..why don’t you try volunteering in a third world country. You will find millions of patients who are willing to give you their last goat for your dedication. At the very least you will return to the UK feeling fulfilled and less frustrated. I find that the entitlement of western patients makes it difficult for us physicians to feel appreciated…..

To Melinda,JPS and the rest. I think you misunderstood the point that the blogger is trying to make.As a Dr in Africa,I fully agree with the blogger,and regardless of how much I listen,smile and trying to be understanding,the majority of my patients are still very rude and have a sense of entitlement.I once stepped out of a consulting room to find a DKA(diabetic keto acidosis) patient collapsed on the floor while the rest of the patients just jumped over him because they didn’t want the inconvenience of having their consultations delayed by an “emergency” patient.So their solution was to just be quiet and not inform me or any other Dr in the consulting rooms that there was a patient outside that needed our urgent attention.Fact: human being are selfish and self serving.We work in very undesirable conditions with lack of resources and equipment and try to do the best with the little we have but adding a bad attitude to it isn’t helping at all.Yes we knew what we were signing up for and took an aoth but part of that aoth doesn’t state that we will be verbally,emotionally and physically abused by those we are trying to help.I was actually physically attacked by a patient who wanted a social grant (welfare)and was under the false impression that it is Drs who offer such grants.
We show up at work everyday and on time,and we are actually not late,but in fact busy elsewhere saving a life.And most Drs apologies to patients for the delay,but unfortunately we mostly get insults and moaning.
Contrary to popular believe we are not over paid,it takes 6yrs to get through med school this side then another 2yrs internship and a year of community service, that is 9yrs in total.Anyone with so many yrs of academic background in other fields is earning way more than we do,and still we do not complain about our salaries. All we ask for is for our patient to understand that we are dedicated to bettering their health,we are on their side,not the enemy.But unfortunately they believe otherwise.
And to the understanding patients,the ones who are grateful,the ones who smile back at us,the ones who adhere to their treatment,who show up for their appointments,who say THANK YOU,we are eternally grateful to you because you make our day,and make our job worthwhile 😉

I don’t understand: there are marketers and advertisers who DEDICATE THEIR LIVES to convincing people to eat unhealthy, smoke cigarettes, and binge drink. These men make millions of dollars each year by externalizing the health costs of their products to the federal government (as the most vulnerable populations tend to have Medicaid and Medicare). And at the end of the day, the fact that U.S. health outcomes lag behind other countries is the healthcare industry’s fault?

I think it is these wicked men we should be angry at, not our patients. You can’t blame sheep for following a wicked shepherd.

I think a possible reason why docs do not explain/react when they are being falsely blamed is because they are kind by nature, that’s why they don’t argue back. Perhaps the hospital, clinics they need to look into ways of how to protect the staffs better from such abuse. Perhaps someone can devise a high tech patient chair in such that when they ever get abusive, press the “eject” button and the patient will be removed from the room.

It is true it is a difficult career. But at the same time, i don’t think that it is okay for docs to have an “expectation” that patients must be kind and appreciative of their efforts. Naturally, they should be appreciative and not react unkindly, abusive etc. But, having said that, patients they are in distress mode. When a person is in distress they do and say things that are wrong. Not trying to justify it is okay for abuse. But just saying as such, the hospital need to be proactive in taking steps to protect staffs from such emotional or physical abuse.

Also, i do think that, if a doc do come across an angry patient who blames about the waiting time etc, the doc should try to explain the reasons why nicely to them, and not apologized for something that is not their fault. By apologizing for something not your fault, in turn u allow the patient to abuse u emotionally. it is not your fault, u stand up against the bully. That’s my feeling. However, even if after explaining nicely to the patient and the patient completely “shut you off” and still behave in hurtful ways, then just try to ignore them. Try not to internalize. I know it is difficult career.

I still think the majority of the patients are OKAY. I don’t think majority are that abusive. Altho yes they grumble on the waiting time etc. That’s because they do not work in healthcare, they are not in your position so they do not understand.

Perhaps because docs have an expectation that all patients must appreciate them and be nice to them because they are helping them. Perhaps it is the expectation of that, that hurts. I don’t think such a day is gonna come. There will naturally be some patients that dun appreciate, but it is not okay to “expect” them to do that. Because just like in a classroom, a teacher teaches enthusiatically but there would still be a few naughty students that bully the nice teacher and hurt the teacher feelings. It seems like it is just the way things are.

I hope there are security guards around when the patient start being physically abusive. Whereas for those day-to-day grumbles just take it easy on that. Don’t “internalize” it.

I don’t really agree. Individuals should take responsibility for their own lives and choices. I knew it was unhealthy to smoke, but yet I smoked (but I did eventually quit). I know fast food is unhealthy, but yet I eat it sometimes. Because individuals choose to support their unhealthy products, these people make money from it.

Sorry doc, its just that we’re all narcissist selfish and rude. I do remember waiting almost 4 hours to see my neurosurgeon. I did so with plenty of deep breaths and self reminders that when I was the one with the emergency, I was ever so grateful for the time and tenderness my doctor afforded me. I sometimes have to shake out the cobwebs and remember that when it is someone else who is in crisis. This was a well written piece that too many people need to read, and more importantly, need to understand that it was written with them in mind!

Judith, thank you for saying this. You truly understand what I was trying to convey.

We don’t expect all patients to understand this. But we know most of you do. It would be nice if more did. But it is patients like you that makes this job worth the while. It is for you I wake up every morning with a reason to live.

I wrote this to defend my fellow doctors. Some are frustrated after years of service and still have to undergo abuse. When we signed up for this, we were told to work hard to serve our fellow mankind to alleviate their suffering. No one told us at that time, we would instead ‘suffer’ in the hands of some. We learnt that once we started working.

In an ideal world everyone is without ego and lives like a saint. Unfortunately, we are all not perfect and as such after years of abuse it gets internalized as we often overlook their behavior as a result of their disease and suffering. Even if it’s only vocal minority. The minorities don’t appear once in a blue moon. They are there daily at times. But we still care for them without prejudice. It comes with the job.

We explain to patients all the time if we are running late and then apologize for keeping them waiting. Most do understand but there are some who just don’t.

I did not stay in service to be appreciated by all. I stay to help as much as I can, to be an instrument to serve others. That’s the reason most of us are there.

Please allow us the occasional indulgence to be human once in a while. We are not perfect. We can be hurt. But when we see you the next day, it all goes away and we will be with you.

This is the obese patients perspective. I go to the doctor and he tells me to lose weight, but I have told him my progress during the visit (lost 30 lbs in the past 4 months … and that I’ve now worked up to exercising an 45 min a day and eating as the dietician has told me). it is quite frustrating when the doctor warns me again that I need to do something about my weight instead of congratulating me on my progress and telling me why it is important to keep it up. I don’t think the doctor believes me even though the scale shows it from my last and current visit. I see various doctors frequently; only one has ever got excited that I lost weight and asked me how I did it. When I order my medical records and see obese and poorly nourished, but no mention of my progress toward the weight loss goal, clearly the doctor is not listening. This is not just one doctor.

I do notice that very few doctors offer any real suggestions on how to lose weight. It would definitely be helpful if there were some list of suggestions that could be provided at the visit. Insurance plans don’t typically cover getting any consistent long-term help either. I was allowed 2 visits per year to the dietician because I was pre-diabetic; Gastric bypass or other surgery is not covered. If you are obese, you probably don’t know what to do about your weight so you need a lot of help, Luckily, I am a pretty good researcher and always been a pretty busy body type person so I’ve learned a lot about what I can do on my own now that internet is available. Also with obese people, there are sometimes there are other things in life going on … my son died and I really just didn’t care about myself for a few years. I understood the consequences of my weight gain and just couldn’t do anything about it then.

Honestly, I kind of feel like the patients who need to read this are likely not of the habit of reading blogs that make social commentary aimed at improving the process. This is incredibly well-founded I think, but is it reaching the people who need to hear it or harboring resentment? Years of clinical training say to just say, “you’re right, it’s entirely my fault”? I don’t think this is meeting the patient and Rumi in the field. To play the cynic, I could refuse to separate the business logic of hospitals from the important and careful practice of medicine and instigate the question that this training seems like it has more of the objective of not loosing the patients’ cash flow (subsidized or not) rather than having the patients’ well-being in mind.

If the pitfalls of the patients’ actions don’t have real consequences (being dropped by a physician), for many, incentive to change behavior is even less so (in addition to other barriers such as bad habit, depression stemming from accepting their condition – a big reason why we have genetic counselors, dementia, a sense of entitlement, poverty and yes, apathy, etc.).

Take a patient with a special medical need, similar to diabetes, that requires dietary changes, weekly monitoring and treatment, preventative action. He is analytical, educated and belongs to the tech savvy generation currently in their 20s and 30s. He appreciates and utilizes the ICT innovation budding out of the field of healthcare informatics right now and how patient portals can significantly improve self-care and the ability of doctors to recall patient history and notes. He blogs. He read blogs by overworked and underappreciated doctors and empathizes and is disheartened that this is happening. He qualifies for medicaid as he works in social services as a caseworker and is paid at the poverty line, right alongside his clients (not uncommon). Receiving assistance with payment of his highly grossing medical bills likely wouldn’t affect his practical and healthy behavior, despite the oversimplified assumption that it leads to entitlement and this kind of attitude. It’s a contract he has made with his government, and his care is a contract made between him and his doctor.

“If I break this contract, there are consequences, because being reckless is a liability to my doctor. He will drop me. Maybe he’ll take me back up, but I know there is a contract between us.”

Maybe I’m idealistic, but I believe that if the pitfalls of the patients’ actions don’t have real consequences (like being DROPPED), for many, there is less incentive to change behavior. If the patient is on public assistance, they likely have a caseworker who will help him/her find a new doctor. It’s not an empathetic move to not address the behavior of the patient and to accept complete fault. It’s a strategic move.

I can understand where you are coming from. This may apply to the healthcare setting in your country.

I am from Malaysia, and healthcare is free and subsidized by the government with very minimal amount charged to the patient. We have one of the best healthcare system around the world. Patients swarm the government hospitals for the free healthcare and the doctors see each and every one of them. The ones with medical insurance or the ones who are wealthy and financially well off may opt to see doctors in private practice. I work in a government hospital.

I can chose to avoid seeing patients. The hospital will not lose money but instead will save some. So it is not a strategic move at all. Unless I am in private practice. Then every patient counts for the hospital.

I apologized to this particular patient as she was verbally abusive although I explained and apologized for the reason of me being late. She wanted the last word and wasn’t going to leave until she got it. I can continue arguing but it will be time consuming and other patients are waiting to see me. So I chose to ‘easy’ way out.

Had I chosen instead to stand up and prove my point, a person with lack of insight will never be able to get me. I have not given up on her. We hope she will in time understand what the doctors are doing for her and she has to play a role in helping herself. But enough about her.

Healthcare is the responsibility of the patient and the doctor. Even if you are at a setting which enables you to see the doctor daily, we need your help and insight to manage your disease. We cannot do it alone. It’s near impossible. But we can do it together.

Remember, regardless of how cynical you think your doctors may be, it’s not possible to continue working in this environment solely motivated by financial gains. We do care. A lot. And that gives us the drive to work every day.

Much of the information and the feelings expressed by the doctor is correct and I sympathize with everything said. However, we should not forget that the doctors (probably forced by the hospital administration) run a large number of unrelated and unnecessary tests (sometime several of each) in order to generate income for the hospital (This has happened to me when I was recently hospitalized). This means that the medicare or the patient is charged for these unnecessary tests. This is an abuse in charging the Medicare and or the patient so the hospital can have more money. There are however, some honest doctors that wont follow the rules and unfortunately end up without the job. It is a crazy and devious world that we live in. In other words we are forced to take it or leave it.

True true true
But every day one or other, thanks me or blesses me , i get energy to move ahead.i know a child can cry with mother,man can blame or complaint to God,so patients can onlyrelay o us for their pains

It’s the fault of the insurance companies and hospitals. Doctors don’t spend enough time with their patients (which is a fact) because insurance companies require doctors to spread themselves as thinly as possible. Maybe you doctors can find a way to Washington to have your voice heard, because, as of now, the only voices being heard are those of health insurance lobbies.

I’m a bit on the fence about this one. I sympathize with the overall idea here but there’s a level of condescension (at least in the first part) I just couldn’t be behind. It wasn’t necessary to say that she was a housewife (meaning she’s dumb?) or that she “gorges” on fast food (which you can’t know for sure). Overall, this definitely shows how a lot of doctors don’t have experience in retail or even other clinical jobs to learn how to deal with this before they go to med school. People are jerks – especially people who are scared, hurting and confused – but that doesn’t mean their comments need to be taken personally. When I was teaching and had kids who got upset with me that they were failing, even though they were not studying or doing any of the exercises I gave them, I let them know exactly how ridiculous they were being. Maybe I’m too harsh but all I can do is my job the best way I know how to and I see no point in apologizing for it and I don’t think doctors should either. The nice and understanding people are usually that way regardless of the level of care they get and the rude and entitled people will be that way no matter how many thorough explanations you give them. If their attitude and compliance is not a marker of how well you are doing then just don’t play that game. Their bodies and lives are their own right to control, after all. If they don’t like what you say, they can go elsewhere, but it seems more damaging not to stand by your words and confidently enforce them. A nervous person will sense weakness in the person that they went to for help and only grow more agitated by it. If you are an authority figure, you have to act like it and demand a certain level of respect.

Still, I know there are days it gets to be too much and you just gotta vent and break a few things too.

Nobody mention that some docs are impatient. They are bad tempered and quick to jump to conclusion and don’t care about if what they said can hurt their patient feelings.

There was a time I went to my family physician GP complain abt my GI problems and my difficulties with public transport due to the GI problem. Suddenly my GP shouted at me saying I was neurotic and didn’t believe I have any problem with my GI. This was the first time I heard him using such a hurtful word on me Neurotic. He told me to stop going to see him. Also the tone was unkind. I was close to crying to crying! Imagine that. I admitted that I could have anxiety.

Even if my gp was right. Even if he was right. Does he need to shout at me. Even if it is due to anxiety it is not my fault even if he was right about me being neurotic. Because when I was in kindergarten I was molested by a stranger adult on a public bus after being abandoned by my mom to sit with the stranger. After that episode the following years in my primary school I developed symptoms similar to what I have now..the side effects of childhood molestation can include anxiety and GI problems. My point is even if I was indeed neurotic okay, he doesnt have to shout at me when I was not even rude when I go into his room. So his shouting was totally uncalled for. His words were so harsh that made me close to crying. Tears were alr filling my eyes. Esp that my problems could be related to the childhood trauma. He didnt even try to understand or find out why. Even tho he was my family GP for 20 years. Even it is anxiety is not my fault that I have problems with taking public transport I get panic attacks n the chronic GI problems..it could well be related to the childhood molest on the bus. So just saying it was unfair he shouted at me.

Nice blog. I have a few pieces of advice. I hope you’ll excuse my presumptuousness in offering them unsolicited.

1. Grow a skin. Didn’t you do a residency? You sound like your feelings are hurt. This is not a job for people whose feelings are easily hurt. I understand that it sucks when patients take a dump on you, but you need to toughen up a little bit. The key to happiness in medicine is to be self directed. You can’t depend on money or appreciation from patients to make you happy. You have to love it for what it is. No doubt you did love it once, but maybe the administrators or the insurance companies or the government busybodies took it away from you. Stop crying about it and take it back.

2. To aid you in accomplishing #1, you need more companionship from your fellow physicians. If you don’t have local friends to go out with and vent with, consider joining one of the physician-only websites. I like Sermo.

3. Also to help with #1. You need to protect yourself a bit more. Make sure you have some protected private life. Whether it’s your family or a hobby, don’t go ‘all in’ on medicine or you will be eaten alive.

4. All of that said, you don’t have to be a doormat. Fire your worst patients. The ones who are still non-compliant and unappreciative are still going to be non-compliant and unappreciative in five years and in the meantime they’re going to make you miserable. Go ahead and have the “This doesn’t seem to be working,” or “You don’t seem to be happy, perhaps you’d do better with another physician” talk with them.

Noncompliant/unhappy patients will make you unhappy, suck a disproportionate amount of time and energy and will run down your PG scores and your actual outcomes.

5. Consider going to a concierge or direct pay model. There are many approaches to this, some are gold plated, but others are suitable for patients of modest means who actually value your services. It will get you off the treadmill and out from under the microscope/colonoscope of Medicare and it’s gun for hire auditors. With the new high deductible Obamacare health plans there will be an increase in demand for these services. This is not patient abandonment, this is keeping you a functional human being and allowing you to continue serving patients.

From an MA’s perspective it’s no better. In fact, it’s a lot worse because we get it coming and going and in the middle. Then we get the frustration from the doctor too. Sometimes a lot of misdirected anger and condescending attitudes are thrown at us on top of our already stressed out workloads. I had one doctor take off for 3 hours to play golf while I had to deal with all his very angry patients. I ask you, is that fair? I didn’t have the option to leave my work and go shopping for 3 hours.

It is true that Doctors have lost respect in society and I feel this is a sad incident, Having worked in OBGYN for more than 10 years I have experienced everything. Anyway coming days are going to be very difficult for Doctors in India.

Hi very well written blog. It continues to amaze me that doctors actually have time to blog! Well I patients should be a little more understanding towards a doctor’s job. Doctors have heavy responsibilities and the last thing they want after a hard day is to get scolded by a patient for being late.

As a practising private physician for over 45 years, I have seen the slow deterioration of the medical profession. There is NO more patient-doctor relationship, but a doctor-insurance company-patient triumvirate. Patients are now being rephrased as CLIENTS and doctors are paid by third party insurance company. Many a times, we have to follow the nonsensical rigid rigmarole of the insurance company or else our payments will be delayed and delayed. Times have changed and doctors are being policed by their own Medical Governing Bodies: Medical Boards or Medical Councils. We may be right 1 million times, but if we are wrong once and have that error be made as the basis of a medical complaint, the whole roof will fall upon us. We are forced to take CME’s and also we have to constantly keep up-to-date with the advances in medicine because time and medical progress marches on. The businessmen who control millions or billions do NOT have this CME to worry about, their failure or success determines their outcome. No wonder brilliant minds will not choose the medical profession, since this will be made into a Civil Service industry in the not too distant future; where doctors are nothing but Federal employees.
That day will come and I do NOT look forward to it; and thankfully, I shall NOT be around to see that day!
Ronald Tan, MD, FRCPC.

Agreed….
But I think, we as doctors need to change our attitude as well. Why apologize when you are not at fault? For me, I would have firmly told this particular patient the reason for being late and asked her to seek a new doctor if she has problems.

I think the apologetic attitude gets ingrained into us during long periods of residency where we are trained to take all the nonsense thrown at us. For most of us, life starts only after residency is over and I have seen some still living the same pattern of life even later.

It is good to be compassionate but that accepting an insult is something I would not tolerate.

I have been to some wonderful Drs. that will answer questions, draw pictures and in just a few minutes, make me feel like the only patient there. I’ve also been blown off about my heart by others that feel my questions aren’t important. I have a heart condition. Chest pains have been worse over the last few months. Back pain has also gotten worse. No cause for the chest pain has been found. I asked if the chest pain could be related to the back pain… Dr. rolled her eyes and said the back and chest aren’t related. Really? If you follow the rib cage from the chest pain, it’s exactly where the back pain is! LOL! Then she says there really isn’t anything we can do about back pain… If she’d have looked at my history, I don’t do pain meds unless I have to… I wasn’t looking for drugs. That was the first and last time seeing her! I miss the great Dr. that moved away… he would have drawn a picture and taken me serious! For ER trips, I bring a book. I’ve sat waiting for discharge while listening to the gun shot wounds come in… I just sit back and read…